Interventions to increase attendance for diabetic retinopathy screening

Area of Science:

• Public Health
• Ophthalmology
• Health Services Research

Background:

• Diabetic retinopathy screening (DRS) is vital for preventing sight loss in diabetic patients.
• Screening attendance rates remain suboptimal despite evidence of effectiveness.

Purpose of the Study:

• To evaluate the effectiveness of quality improvement (QI) interventions in boosting DRS attendance.
• To identify specific QI strategies and behavior change techniques (BCTs) associated with improved attendance.
• To explore cost-effectiveness and equity implications of QI interventions for DRS.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating QI interventions for DRS attendance.
• Searched multiple databases up to February 2017, including Cochrane Library, MEDLINE, and Embase.
• Coded interventions using EPOC taxonomy for QI strategies and BCT Taxonomy v1 (BCTTv1); assessed risk of bias and certainty of evidence using GRADE.

Main Results:

• 66 RCTs (329,164 participants) showed QI interventions increased DRS attendance by 12% (RD 0.12) compared to usual care (low-certainty evidence).
• Both DRS-targeted and general QI strategies were effective, especially in populations with low baseline attendance.
• Specific BCTs like 'goal setting' and 'feedback on outcomes' demonstrated higher effectiveness in patient-targeted interventions.

Conclusions:

• QI interventions effectively improve DRS attendance among patients with type 1 and type 2 diabetes.
• General QI strategies for diabetes care offer additional benefits beyond improved screening rates.
• Further enhancements in attendance may be achievable by intensifying or adding QI components.